Gender Transition

This systematic review assessed the state and quality of evidence for effects of gender-affirming hormone therapy on psychosocial functioning. Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified. Gender-affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress. Evidence for quality of life was inconsistent, with some trends suggesting improvements. There was some evidence of affective changes differing for those on masculinizing versus feminizing hormone therapy. Results for self-mastery effects were ambiguous, with some studies suggesting greater anger expression, particularly among those on masculinizing hormone therapy, but no increase in anger intensity. There were some trends toward positive change in interpersonal functioning. Overall, risk of bias was highly variable between studies. Small samples and lack of adjustment for key confounders limited causal inferences. More high-quality evidence for psychosocial effects of gender-affirming hormone therapy is vital for ensuring health equity for transgender people.

Like “detransition,” “regret” can also have different meanings. Narayan et al. (2021) surveyed surgeons who perform gender-affirming surgeries about their experiences with patient regret (which they reported to be in the 0.2–0.3% range). They documented three different “types” of regret: “true gender-related regret” (typically a change in gender identity), “social regret” (typically due to external pressure from family members or societal transphobia), and “medical regret” (e.g., complications due to surgery). Notably, they reported that only 6.5% of patients who experienced regret believed that they had been “misdiagnosed.”

In other words, just as we shouldn’t conflate “detransition” with “regret,” we also shouldn’t conflate “regret” with inadequate assessment or having been misdiagnosed as transgender. Once again, this confirms my previous point that the “mistaken and regretted transition” narrative only applies to a small fraction of those who detransition, and thus represents a miniscule number of people who choose to transition in the first place.

To put these numbers in perspective, let’s try a thought experiment: Imagine 10,000 people transitioning. If 2% of them experienced detransition or regret, but only 6.5% of those individuals felt that they had been misdiagnosed as transgender in the first place, that would represent 13 people. Out of 10,000. That’s an incredibly small number of people — no wonder journalists and politicians who want to promote the “mistaken and regretted transition” narrative have to rely on the same handful of detrans interviewees over and over again.